Affordable Connectively Program Application

APPLICATION

Please Note: All the information you provide on this application MUST match the information you provided on the National Verifier Application. If the information doesn’t not match exactly your application will be rejected and we will be unable to provide you with the ACP Benefit.

Name of Applicant *

Date of Birth *

Last 4 of SSN (If alternate form of ID was provided to USAC, please enter 0000 below) *

Are you or someone in your household a current Adams Cable Internet customer?

Yes
No

If YES, please provide the last 6 digits of your account number *

Street Address *

City *

State *

Zip Code *

Phone Number where you can be reached *

Email *

ACP Application ID (Begins with a B or Q followed by 10 digits) *

Did you qualify for Lifeline or The Affordable Connectivity Program Benefit Through a Child or Dependent?

Yes
No

***PLEASE NOTE: You the applicant can NOT be the Benefit Qualified Person (BQP)****

If Yes, please provide the First and Last Name of the Benefit Qualified Person (BQP)

Are you currently receiving the ACP Benefit from another provider (ex. Wireless phone carrier) and want to transfer the ACP Benefit to Adams Cable Service?

Yes
No

***Please Note: If you are currently receiving the benefit and answer “NO” to this question, your application will be rejected by the government upon final review and we will be unable to provide you with the ACP Benefit.***

I agree to give permission for Adams Cable Service to enroll me in the Affordable Connectivity Program to receive reimbursement for my services *

I agree

I agree to continue receiving internet service after program end under Adams Cable Service's normal policies unless I call to cancel *

I agree

I agree to the acknowledgment and consent for enrollment terms. *

Yes

Enrollment Terms

I agree to the acknowledgment and consent for transfer terms. *

Yes

Transfer Terms

Please submit no more than one application. If multiple applications are submitted, they will be viewed as spam. All additional applications will be instantly deleted and unprocessed, which may prevent you from getting final approval for the ACP Benefit.

I understand

19 N Main St,
Carbondale, PA 18407

570-282-6121

Customer Support 24/7

Office HoursMonday – Friday : 8:00AM – 4:30PM
Saturday : 8:00AM – 4:30PM

What Customers Are Saying

Ken came out to swap out a faulty modem box, but also checked connections, checked switches and wifi “stuff” and thoroughly made sure all is working well. Extremely polite gent. But that is what Adams Cable peeps are. Kudos to Ken

LUCIA LAKE HENRY, PA

Customer service has been above and beyond. The installer was kind and explained what I needed to know in an understandable way. Great Employee. He represents Adams Cable very well.

KAREN PORT CRANE, NY

This afternoon something different popped up on my TV screen and I didn’t know how to remove it. I called Adams and spoke with Beth and she calmly walked me through each step. Anytime time I have called for help, they are all very helpful, kind and knowledgeable.

MARIA JEFFERSON TWP, PA

We want to thank you for your outstanding service. When in Florida we have had to deal with Spectrum. They could learn a lot from you! After a lightning strike, we were left without phone, TV, or internet connection. I called your office the next morning and the tech arrived within the hour. The tech was fast and efficient and had us up and running in record time.

JOYCE NICHOLSON, PA

APPLICATION

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What Customers Are Saying